Direct answer
It depends on whether your plan is an HMO or PPO, as HMOs often require a referral and specific network participation to avoid full out-of-pocket costs. If you see a specialist out-of-network without prior authorization, your plan may offer zero coverage, leaving you responsible for the entire bill.
Standard summary of benefits and coverage documentation provided by health insurance carriers. For additional information about how insurance plans define and cover medical costs, see the Healthcare.gov glossary of health coverage and medical terms.
What this means for you
It depends on whether your plan is an HMO or PPO, as HMOs often require a referral and specific network participation to avoid full out-of-pocket costs. If you see a specialist out-of-network without prior authorization, your plan may offer zero coverage, leaving you responsible for the entire bill.
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This page is informational and not a coverage guarantee or quote.